Three hundred and fourteen patients undergoing coronary artery or peripheral vascular disease were screened for carotid artery occlusive disease. Using periorbital and direct carotid Doppler screening techniques, 54 arteries in 41 patients (13.1%) had hemodynamically significant carotid obstructions and 18 (33.3%) of these had a bruit. Of the 314 patients in our study, 34 had asymptomatic bruits in 48 of their carotid arteries. No perioperative strokes occurred in the patients who had carotid obstructive disease and did not have a prophylactic carotid endarterectomy. From this data, no evidence supports prophylactic carotid endarterectomies to prevent perioperative stroke in patients who are candidates for coronary bypass or peripheral vascular procedures. Our future goals include following up these patients to determine the late postoperative morbidity and mortality due to stroke or myocardial infarction as related to the presence or absence of carotid obstruction and/or bruit.